Spiral Enteroscopy: A safe and effective method of diagnosis and treatment for patients

Dr Ravindra B S, Director-Gastroenterologist, Fortis BG Road talks about spiral enteroscopy and its various parameters

The small intestine was once an uncharted territory in gastrointestinal endoscopy. Enteroscopes have improved access to this part of the gastrointestinal tract, but it is still a rigid organ to reach. Until recently, endoscopic procedures could not access the majority of the small bowel without requiring additional surgery.

Despite recent technical advancements, an endoscopic inspection of the small bowel remains a challenge; because of the small intestine's length and attachment to a free mesentery, regular endoscopic advancement is rendered ineffectual due to proximal looping. The small intestine has always been a complex area, and beyond the reach of standard endoscopes, it has always been a challenging place for endoscopists to approach.

Obscure Gastrointestinal Bleeding (OGIB) is one of the most challenging conditions for gastroenterologists to diagnose because of its evasive character and the difficulties in establishing the exact source of bleeding. Patients usually have an endoscopy and a colonoscopy to diagnose the origin of their bleeding, but identifying the source can be challenging in some circumstances.

The most popular form of enteroscopy, push enteroscopy, was established in the 1980s and has since become the most common, but examination is usually limited to the proximal jejunum. Intraoperative enteroscopy successfully reaches the ileum in more than 90% of instances. However, it is used less frequently due to its high invasiveness.

Spiral enteroscopy is a relatively recent method today that employs a unique scope with a spiral overtube. Current endoscopic modalities seldom complete entire gastro-intestinal examinations, and when they do, they sometimes take several hours. The capacity of the Spiral Enteroscopy to quickly diagnose and treat intestinal lesions makes it a contender to replace capsule endoscopy, which can be inconclusive and need patients to undergo a second surgery for treatment if pathology isn't found during the initial round of examination.

It is a minimally invasive technique with a motorized endoscope with a specific motor that travels into the small intestine's 22-foot length that helps in the diagnosis and treatment of small intestine problems and has ushered in a paradigm shift, proving to be a boon not only for patients but also for clinicians. The cutting-edge technology is an excellent tool for small-bowel diagnostics and treatments, with the procedure's speed and convenience contributing to its appeal.

The spiral section of the motorized spiral enteroscopy is rotated by an internal motor controlled by a foot pedal. The forward pedal causes the spiral segment to revolve clockwise. This causes the gut to pleat, allowing the endoscope to be safely inserted into the intestine. The backward pedal causes the bowel to unpleat, allowing the endoscope to be taken out of the patient's body via reverse spiral rotation after examination or treatment of the small intestine. The diagnosis and treatment of small intestinal lesions can be made in a brief period. It can be used to control hemorrhage, dilate strictures, cut polyps, and remove foreign bodies as part of its therapeutic potential.

What are the benefits of spiral enteroscopy?

Benefits of spiral enteroscopy:

Insertion is smooth, safe, and deep

With Spiral Enteroscopy, the surgeon will stop small bowel bleeding more quickly and remove any foreign bodies that may be present. The motorized advancement, paired with the spiral segment's soft fins, allows for smooth, safe, and deep insertion, as well as exceptional maneuverability, allowing for complete visibility of the intestinal lumen. All of these qualities work together to make it easier to get deep into the small intestine.

Efficacy and user-friendliness in therapeutic interventions

The endoscope can be precisely positioned thanks to the mild hold on the mucosa of the spiral segment's soft fins. Your view is kept precise thanks to the built-in water jet. The Spiral provides efficient interventions with a wide range of endo-therapeutic devices because of its standard endoscope length.

Significantly reduced procedure time

In the event of lesions, the surgeon would reach them with greater precision, and the procedure would take no longer than 45 minutes. Lesions may be reached faster due to greater overall mobility. The first study found that using the Spiral endoscope might significantly cut operation times.

Spiral enteroscopy represents a significant shift in how we perform small-bowel endoscopy and how we think about endoscopy in general. After power spiral enteroscopy an endoscopy, colonoscopy and CT abdomen to look into small bowel. This is useful in small bowel bleeding, small bowel ulcers, small bowel tumor detection and biopsy. This procedure is used amongst thin individuals and post operative abdomen procedures.

The spiral procedure appears to be better than other assisted enteroscopy because the over the tube, which holds the endoscope in place with a couple during spiral advancement and allows it to be disengaged for conventional manipulation, allows the scope to be removed and reintroduced after each polypectomy while keeping the position deep in the small bowel.

Understanding the usefulness, purpose, and timing of spiral enteroscopy in a patient's evaluation is critical. Spiral enteroscopy should only be used in the case of chronic problems. Enteroscopy should not be used as the first step in assessing patients who are suspected of having a chronic condition.

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